COVID-19 has rapidly compounded problems shift workers and gig economy contractors face, with implications for individual, family, and community health. What can we do to advance health equity in this new reality? Apply for funding to help us explore.
Editor's Note: The health impacts of our rapidly changing work environment are often overlooked. Since 2018, when this post was first published, we reported on the health equity implications of unstable incomes, unpredictable schedules, and lack of access to paid sick leave. In the wake of COVID-19, these questions about health equity are more important than ever. See what we’ve learned, and apply for funding to explore what the next five to 15 years may hold for workers.
When her regular job hours were cut, Lulu, who is in her 30s and lives in New York, couldn’t find a new full-time job. Instead she now has to contend with unsteady income and an erratic schedule juggling five jobs from different online apps to make ends meet. Cole, in his first week as a rideshare driver in Atlanta, had to learn how to contend with intoxicated and belligerent passengers threatening his safety. Diana signed up to help with what had been described as a “moving job” on an app that links workers with gigs. When she arrived, she had to decide whether it was safe for her to clean up what looked to her like medical waste.
Work is a powerful determinant of health. As these stories about taxi, care, and cleaning work from a 2018 report show, it is a central organizing feature of our lives, our families, our neighborhoods, and our cities. And work—its schedules, demands, benefits, and pay—all formally and informally shape our opportunities to be healthy.
But the world of work is rapidly changing. Job instability and unpredictable earnings are a fact of life for millions. Regular schedules are disappearing. With “predictive scheduling,” a retail worker today is essentially on call, making everything from booking child care to getting a haircut impossible until the work schedule arrives. Health and other fringe benefits are less often tied to the job. Nearly six in ten low-wage workers today have no paid sick leave. Two-thirds lack access to employer-based health care benefits.
And what is workplace safety when there is no workplace? In the gig economy, marketplace matching apps and others can create difficult trade-offs for workers who depend on the income. If a worker leaves a job undone because she feels unsafe in a male client’s presence, for example, or if she is asked to do a different job than she signed up for, the client can give her a one-star rating and the worker will have little recourse. When online platforms like these tie ratings to higher pay, the incentive for workers is to put the job before safety.
And more change is on the way. In the past 20 years, the growth of jobs in the gig economy—including self-employed freelancers and contractors—have far outpaced the growth of traditional firms. Some economists estimate this sector currently makes up roughly one-third of the U.S. workforce and may reach 43 percent of all U.S. jobs in the next two years.
Wellbeing in the Future Workplace
All of this affects health and wellbeing. Our job at the Robert Wood Johnson Foundation (RWJF) is to look at emerging trends and their implications for health and health care. Through our efforts to elicit pioneering ideas around the future of work, we’ve been exploring interventions to improve wellbeing in the workplace.
We’ve been thinking about three areas in particular. First, we’ve been exploring how the nature and structure of work detract or contribute to our wellbeing. How, for example, do erratic schedules affect diet and sleep? The evidence is pretty clear that they both suffer. Long days, back-to-back shifts, and unpredictable work hours also make parenting harder and high-quality child care nearly impossible to secure. Financial instability creates chronic stress, which has a destabilizing effect on health. Not only do vacillating incomes make it difficult to afford a doctor, but the chronic financial worries have a cumulative effect on the body.
Second, our grantees have identified numerous examples where discrimination and bias, both intentional and unintentional, go unchecked in the gig economy, and traditional worker protections are absent, deepening vulnerabilities.
Takarah, for example, cleans homes in New York City by finding gigs on an app. The app company’s policy protects their cleaners against “no-show” clients by paying them a kill fee so long as they remain within 500 feet of the no-show client’s home for at least 30 minutes after the scheduled start time. The app tracks their location. But for some women like Takarah, waiting can get uncomfortable, particularly when she is working in wealthy, predominantly white neighborhoods like the Upper East Side.
"It’s uncomfortable because I am black and...I stand out” as she waits out her 30 minutes on the stoop or sidewalk near the home. “So I don’t like to be in that situation,” she told researchers of a study we funded called “Beyond Disruption.” She will sometimes opt to leave, and forfeit her kill fee for the client’s no-show. “Sometimes I don’t get paid for that and I don’t think that is fair.”
The app’s wait policy does not take into account the way racism shapes the kinds of scrutiny and risks that people of color may face in public space.
Finally, and on a more basic level, health insurance is increasingly the responsibility of the employee to secure, particularly in low-wage work and the gig economy. Policies such as the Affordable Care Act have taken steps to address this by allowing individuals to buy affordable health care on their own. Other innovations such as portable benefits uncouple health care from an employer. The construction industry, for example, allows workers to take their health care with them when switching jobs within the industry. In other fields, customer surcharges help pay benefits. Alia, a mobile platform created by Fair Care Labs, the innovation arm of the National Domestic Workers Alliance, collects money from clients to fund benefits for house cleaners such as sick leave, disability, and life insurance.
In our work, we’ve found that employers want to do the right thing but need help finding a clear path. Therefore, we supported the development of the Good Work Code, eight simple values that begin to codify a set of rights and obligations for both workers and employers. If you’re hiring a home-care worker, what’s a fair wage and how should you treat someone? And the flip side, what is good quality work? The code is a first step in promoting good standards and being clear about what those are.
People in the United States spend half their waking hours at work. We need both vibrant economies and jobs that enable people to live the healthiest lives they can. As RWJF works to build a national Culture of Health, we will continue to study the effects of work on health and health equity and find ways to ensure the changing world of work supports good health.
In the short-term, COVID-19 is rapidly compounding the problems shift workers and gig economy contractors face. In the long-term, it is imperative that our nation addresses the health and well being of all workers in an equitable way. Until we do, the health of our communities and the economy will remain in peril.
RWJF is announcing a new funding opportunity to explore pioneering ideas about the future, including the future of work. We want to understand how changes to the nature and structure of work in the next five to 15 years may impact health, equity, and wellbeing.
Learn more and start your application today.
About the Author
Paul Tarini, senior program officer, focuses on exploration, discovery, learning, and emerging trends that are important to building a Culture of Health, as well as fostering connections between health and healthcare.